By Derick Rwakibale
Understanding Hepatitis B
Hepatitis refers to the inflammation of the liver, and viral hepatitis is caused by specific viruses. The most common types of viral hepatitis are A, B, C, D, and E. While hepatitis A and E usually lead to acute, self-limiting infections, hepatitis B (HBV) and C (HCV) may progress into chronic infections, leading to serious complications such as liver cirrhosis, liver failure, and hepatocellular carcinoma (HCC). Notably, hepatitis D can only exist alongside hepatitis B.
Globally, over 2 billion people have been exposed to HBV, with the highest numbers found in sub-Saharan Africa and Southeast Asia. Currently, 257 million people live with chronic hepatitis B, while 71 million are affected by chronic hepatitis C. In Uganda, 4.1% of the population aged 15-64 is estimated to have chronic hepatitis B infection (UPHIA, 2016), with the highest prevalence in northern regions and the lowest in the southwest.
How Hepatitis B Is Transmitted
Hepatitis B is primarily transmitted through contact with infected blood or other body fluids. Key modes of transmission include:
- Mother-to-child transmission at birth (perinatal transmission)
- Exposure to infected blood (horizontal transmission)
- Sharing needles or sharp objects
- Sexual intercourse with an infected person
- Blood transfusions, particularly when blood has not been properly screened.
Consequences of Hepatitis B Infection
The outcome of hepatitis B infection depends on the age at which a person is exposed.
- Neonates: More than 90% develop chronic infection.
- Children under six: 30%-50% develop chronic infection.
- Individuals exposed after the age of five: Over 90% clear the infection naturally within six months.
Those who do not eliminate the virus progress into the chronic phase, which may have different outcomes. Around 30% develop complications such as liver cirrhosis or liver failure, while the remaining 70% have inactive disease and may not require treatment.
Signs and Symptoms of Hepatitis B
Many people with hepatitis B are asymptomatic, meaning they experience no symptoms. When symptoms do occur, they may include:
- Fever, fatigue, malaise
- Abdominal discomfort (especially in the right upper quadrant)
- Nausea, diarrhea, anorexia, vomiting
- Yellowing of the eyes (jaundice), liver failure, and an enlarged liver.
Diagnosis of Hepatitis B
To diagnose hepatitis B, healthcare providers may order:
- Hepatitis B surface antigen (HBsAg) tests, positive for more than six months
- Hepatitis B core antibody (IgM negative, IgG positive) to rule out acute infection
- Liver function tests, repeated at six months
- Hepatitis B viral DNA tests, if available
- Complete blood count and abdominal ultrasound scans.
Prevention of Hepatitis B
The most effective ways to prevent hepatitis B include:
- Vaccination: Routine vaccination is key.
- Screening donor blood: All blood products must be screened before transfusion.
- Safe injection practices: Using sterile needles and medical equipment.
- Infection prevention protocols: Universal precautions should be followed in healthcare settings.
- Health education: Sensitizing the public about risk behaviors and prevention.
Treatment of Hepatitis B Infection
The goal of treating hepatitis B is to prevent or reverse liver-related complications. A healthcare provider will determine whether a patient is eligible for treatment based on various criteria. Specific treatment goals include:
- Biochemical: Normalizing liver enzyme (ALT) levels.
- Virological: Suppressing HBV viral load.
- Histological: Improving liver tissue health.
For patients not eligible for treatment, regular reviews at least once a year or whenever they feel unwell are essential.
Monitoring Patients on Antiviral Treatment
Patients receiving treatment should be reviewed after one month and at three months to assess adherence and side effects. After six months, tests such as urinalysis or renal function tests should be conducted to monitor for drug toxicity. Annual tests should also be done to evaluate the response to treatment.
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